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Home care agencies, who took quite a financial pounding in Gov. Andrew Cuomo’s budget as well as his plans to redesign Medicaid, are looking to rural lawmakers for some bi-partisan support.

Democratic Assemblywoman Aileen Gunther and Republican Senator Catharine Young are both working with the group to on bills that would get some money and regulatory relief for home health care in rural areas. Both women represent rural areas, Gunther in the Catskills and Young in the farm country of western New York.

Here are the details:

The Home Care Association of New York State (HCA) is working with the joint Legislative Commission on Rural Resources to advance initiatives aimed at supporting home care services in rural New York at a time of enormous challenges for rural areas and for rural health systems which rely on these critical access community-based programs.

HCA’s collaboration with the Commission has yielded state legislation that would provide for: flexibility and regulatory relief for home care services; authority to implement and test innovation in staffing and service; and funding for home health collaboration, affiliation and sustainability of services.

Home care is provided to patients who are: elderly, chronically ill, in need of hospital after-care or therapy, or suffering from an unstable or disabling condition. For many of these patients in rural areas of New York State, home care is the primary and most cost-effective point of access to routine chronic-disease management or preventive health and assistive services. These services help keep patients out of hospitals, nursing homes or other higher-cost settings.

Established in 1982, the Legislative Commission on Rural Resources is a bipartisan commission charged with examining the impact of rural resources on the state’s economy, reviewing existing laws/regulations as they relate to rural resources, assessing the effectiveness of programs designed to promote rural viability, recommending and sponsoring legislation, and otherwise promoting activities that will enhance and protect rural resources. More than 80 percent of New York State is comprised of rural communities with around 3.3 million residents in 44 rural counties, according to the U.S. Census Bureau. The influential Commission is unique in its bipartisan structure. Legislation supported by the Commission is cosponsored by all ten Senators and Assembly Members who serve on the body. The Commission Chair is Senator Catharine Young (R-Olean) and its Vice Chair is Assemblywoman Aileen Gunther (D-Forestburgh).

Senator Young said: “One of the main duties of the Legislative Commission on Rural Resources is to promote the sustainability, quality and efficiency of systems that serve the needs of New Yorkers living in rural areas. One such system, home care, is a lifeline for many patients in rural New York. It helps keep patients out of higher-cost care settings and it plays a vital role in coordinating with rural hospitals, nursing homes, and physicians to serve the diverse health care needs of the community. By partnering with the home care community on solutions to the many challenges facing home care in rural New York, we can enhance services, reduce costs and ensure the continued viability of these safety-net services.”

Assemblywoman Gunther said: “Creative and strategic policy changes can make a world of difference in helping citizens, local governments and businesses overcome the challenges of serving rural communities by maximizing local resources and systems. Home care is greatly valued in rural communities because it brings services directly to patients in households that are often spread out across large geographic distances. Without home care, many of these patients are at risk of losing access to long term and preventive health care in regions of New York where travel to a physician’s office, clinic or other centralized health care provider is simply not feasible. As a cost-effective community resource, home care is especially equipped to maximize policy changes that allow for greater flexibility, which is all the more important given the unique challenges facing rural home care providers.”

In collaborating with HCA on rural home care issues, the Commission is introducing three bills in both the Senate and Assembly that would specifically:

· Include home care agencies among existing health care entities that are eligible for discretionary grant funding under the HEAL-NY program to facilitate collaboration, affiliations or the sustainability of service in the community “to strengthen and protect continued access to essential health care resources.” (S.5446/A.7892)

· Allow home care provider access to the Health Occupation and Workplace Development program, which allows providers to apply for state waivers or regulatory flexibility for the purpose of innovating or streamlining operational procedures, state mandates, and personnel requirements in order to promote efficiency or quality. Provider experiences under this program are then considered by the state as a basis for broader policy changes. (S.5447/A.7893)

· Establish a Rural Home Health Flexibility Program to establish a provider application and state authorization framework for essential regulatory relief – including those instances when regulatory mandates are identified by the state itself as having deleterious regulatory burdens on rural communities and small businesses – to promote feasibility, efficiency and quality of home health service development and operation through new and/or existing home care services for the community, including proposals to enhance the administration, services and quality of care. (S.5448/A.7895)

HCA President Joanne Cunningham said: “Rural home health care providers face enormous challenges in the provision of services to vulnerable New Yorkers. In many rural locations throughout the state, a single home care agency provides services to patients spread out across multiple sparsely populated counties. Beyond geographic conditions, the rural home care delivery system is further challenged by workforce scarcity issues, local economic conditions, a lack of auxiliary social services or related health and medical supports, and unprecedented Medicaid and Medicare reimbursement cuts that have led to home care agency closures and other forms of downsizing, further straining the system and threatening access to care.”

She added: “I applaud the Legislative Commission on Rural Resources, especially its leadership in Senator Young and Assemblywoman Gunther, for working with the home care community on these legislative proposals, which will help alleviate some of the pressures on rural home care agencies through cost-saving regulatory relief, workforce development programs, and incentives aimed at care collaboration – all of which track with state policy and reform goals.”

In addition to the Commission bills, Assemblywoman Gunther and Senate Health Committee Chairman Kemp Hannon (R-Garden City) are sponsoring another important HCA-developed bill (A.7894/S.5048) which would permit nurses and patients/family members to instruct home care aides in certain programs to provide care that would otherwise be permissible for family members under the scope of nursing. It is projected that this legislation would result in over $20 million in state-share Medicaid savings. HCA advanced this efficiency proposal among other initiatives in recent months as a means of achieving constructive cost-savings in the state’s Medicaid program.

HCA and the Commission have also discussed other legislative proposals to protect the sustainability of rural home care access. As part of this effort, the Commission will be assembling roundtable meetings that bring together home care agency directors from rural and upstate communities to further discuss with the Commission ways of overcoming home care service or operational challenges in rural areas and help to inform a legislative action plan that addresses these issues through legislation or other means.

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